Identifying Feigned ADHD in College Students: Comparing the Multidimensional ADHD Rating Scale to Established Validity Measures.

OBJECTIVE: There is increased concern for malingering in ADHD evaluations due to presence of incentives such as accommodations and medications. Although several validity tests are available to classify malingering in non-ADHD populations, there is no test with proven effectiveness to detect feigned ADHD. This study investigated the ability of the MARS Symptom Validity Index 4 (MARS SV-index 4) and two published validity tests (the Word Memory Test [WMT] and Clinical Assessment of Attention Deficit-Adult [CAT-A] Infrequency scale) to detect malingered ADHD. METHOD: The participants consisted of 68 young adults, 34 with ADHD. Participants completed the MARS, CAT-A, and WMT validity measures. RESULTS: The MARS SV index-4 demonstrated higher sensitivity rates for simulated malingering (61.8%) at close to optimal specificity (88.2%) compared to two published tests (which had sensitivity <42% at specificity >90%). CONCLUSION: The MARS shows good ability to detect feigned ADHD and appears to be useful for adult ADHD assessments.

The Multidimensional ADHD Rating Scale: A measure of symptoms, impairment, and symptom validity.

Objective: Two studies examined the psychometric properties of the Multidimensional ADHD Rating Scale (MARS), which assesses ADHD symptoms, related functional impairment, and symptom validity (SV). Method: Study 1 used MARS item responses from college students with and without ADHD (with some of the latter group assigned to feign ADHD) to create an SV-index, and to identify optimal cut scores for the clinical (symptom and impairment) indexes. Study 2 cross-validated the findings on a new sample. Results: In both studies, malingerers reported more symptoms and impairment than participants with ADHD, who reported more symptoms and impairment than controls. Receiver operating characteristic analyses found very good discrimination of genuine ADHD from control cases by the clinical MARS indexes, and very good discrimination of genuine ADHD from malingered ADHD by the SV-index. Conclusion: This research provides initial support for the effectiveness of the MARS to detect simulated cases of malingering, and to differentiate ADHD from non-ADHD cases in college students.

Assessment and Treatment of a Young Adult with Congenital Heart Disease and ADHD.

CASE: Phillip is a young man born with hypoplastic left heart syndrome referred to your practice for a range of mental health concerns. He underwent palliation to an extracardiac Fontan in infancy and experienced multiple complications over the next decade including valvular regurgitation and arrhythmias necessitating a pacemaker. Phillip continued to have systolic heart failure with New York Heart Association class II symptoms, managed with 4 medications and anticoagulation.Despite this complex history, Phillip had intact cognitive abilities, achieved typical milestones, and performed well academically in secondary school. His first year of college proved to be more challenging, and Phillip presented to the outpatient psychiatry service with an acute depressive episode. His family history included depression, without known attention-deficit/hyperactivity disorder (ADHD). Treatment, including a selective serotonin reuptake inhibitor, cognitive behavioral therapy, and family support, led to near resolution of his symptoms of depression.In subsequent appointments, Phillip described a long history of inattention and disorganization with onset in childhood. This contributed to the decision to leave college, despite remission of symptoms of depression. Phillip was unable to study for any extended period without "perfect conditions," described as the absence of potential distractions except for background music. Despite attempts to maintain "perfect conditions," Phillip was often off task and "hyperfocusing" on irrelevant topics. Phillip struggled with planning and time management and would misplace items daily. Moreover, although the importance of self-care was well understood, Phillip often forgot to take his cardiac medication or to exercise, and he admitted to inconsistent sleep habits because of losing track of time.Based on a comprehensive psychiatric evaluation including retrospective report from a parent, Phillip was diagnosed with ADHD, coexisting with major depressive disorder, in remission. Significant ADHD symptoms were documented by interview, self-report, and administration of an abbreviated neuropsychological battery.Considering concerns regarding use of stimulants in a patient with congenital heart disease, including death, stroke, and myocardial infarction,1,2 how would you assess the risks-benefits of use of stimulants with Phillip? REFERENCES: 1. Wilens TE, Prince JB, Spencer TJ, et al. Stimulants and sudden death: what is a physician to do? Pediatrics. 2006;118:1215-1219.2. Zito JM, Burcu M. Stimulants and pediatric cardiovascular risk. J Child Adolesc Psychopharmacol. 2017;27:538-545.

Effects of Concussion in Adolescent Students: Perceptions and Performance.

OBJECTIVE: The purpose of this study was to compare adolescent students with and without concussion on a battery of academic, neurocognitive, and socioemotional measures and assess the aftereffects of concussion across domains of functioning. METHODS: Twenty-four adolescents (ages 13-17) reporting postconcussion symptoms were compared to 24 controls matched for age and gender across a battery of tests and surveys. RESULTS: After correcting for multiple comparisons, there were no significant differences on any neuropsychological measures. Similarly, there were no significant group differences on academic measures of vocabulary, word recognition, or reading comprehension. Self-reported concussion symptoms were much greater for students with concussion, as were self-reports of anxiety, depression, and somatization symptoms. Parents also rated those with concussion as having greater depression and somatization symptoms, but not to a degree that survived Bonferroni correction. Lastly, those with concussion reported a significantly greater number of school problems and academic concerns. CONCLUSIONS: Results indicated that adolescents who reported postconcussion symptoms do not perform differently from peers on most neurocognitive and academic tasks, yet they showed considerably more worry, somatization, academic concerns, and feelings of inadequacy than matched controls. The findings suggest that interventions to address psychological and academic stress may be indicated for adolescents symptomatic from concussion.

Parent Knowledge and Perceptions of Concussion Related to Youth Football.

Introduction There is increased concern about concussion in youth athletes, yet there is little research on parent knowledge of concussion. Purpose  The purpose of the current study was to investigate attitudes to and knowledge of concussion among parents of youth football players. Methods We surveyed 180 parents/guardians of youth football players, ages 5-12, regarding their knowledge and beliefs concerning concussion. Results We found that the vast majority of respondents (86%) had confidence in their ability to recognize concussions. Yet, a significant number also held misconceptions about concussions, such as 'too much sleep' (48%) or 'eating certain foods' (26%) make concussion symptoms worse. Most (82%) had not heard of the Zurich guidelines, and less than half (44%) were aware that sustained mental activity could worsen symptoms. Parents were concerned about their child sustaining a concussion, but a substantial minority also reported 'serious concern' about their children losing playing time or their position.  Discussion Results are somewhat positive in terms of parents' general knowledge of concussions; yet, response variability and misconceptions point to a continued need for concussion education for parents. Medical professionals can play an important role in informing families about concussion symptoms, management, and recovery.

Sluggish Cognitive Tempo and Speed of Performance.

OBJECTIVE: This study examined whether college students who reported higher levels of sluggish cognitive tempo (SCT) symptoms were actually more "sluggish" in their performance while completing speeded cognitive and academic measures. METHOD: College students ( N = 253) completed self-reports of SCT and their reading and test-taking abilities as well as tests of processing speed, reading fluency, and reading comprehension. RESULTS: Across all variables, SCT symptoms were most significantly associated with self-reported difficulty on timed reading tasks. However, students with high SCT scores were not significantly slower than controls on any of the timed tasks. CONCLUSION: In college students, self-reports of high SCT levels do not suggest actual slow performance on cognitive and academic tasks.

Misconceptions about traumatic brain injury and recovery among nursing students.

OBJECTIVE: To identify potential misconceptions that nursing students have regarding traumatic brain injury (TBI) and recovery. DESIGN: Descriptive questionnaire. SETTING: University. MAIN MEASURE: Thirty-item questionnaire addressing knowledge about TBI and recovery. PARTICIPANTS: One hundred eight undergraduate students, 65 in the prenursing program and 43 nursing majors. RESULTS: In general, nursing students had a lower frequency of misconceptions than did university students in a prior study, and the more advanced nursing majors had a lower frequency of misconceptions than did the prenursing students. Substantial misconceptions did exist, though, especially concerning unconsciousness, amnesia, and recovery. CONCLUSIONS: Nursing students possess several misconceptions pertaining to TBI and recovery that have the potential to adversely affect assessment, treatment, and education of patients and family members. Education focusing on TBI and recovery should be included in the nursing curriculum and be a part of continuing education at the professional level.